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Tödt, Tim
Publications (10 of 17) Show all publications
Maret, E., Liehl, M., Brudin, L., Tödt, T., Edvardsen, T. & Engvall, J. (2015). Phase analysis detects heterogeneity of myocardial deformation on cine MRI. Scandinavian Cardiovascular Journal, 49(3), 149-158
Open this publication in new window or tab >>Phase analysis detects heterogeneity of myocardial deformation on cine MRI
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2015 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 49, no 3, p. 149-158Article in journal (Refereed) Published
Abstract [en]

Abstract Objectives. Myocardial scar will lead to heterogeneous left ventricular deformation. We hypothesized that a myocardial scar will display an elevated standard deviation of phase and that this effect could be compared with mechanical dispersion. Design. Thirty patients (3 women and 27 men) were investigated 4-8 weeks after ST-elevation myocardial infarction treated with percutaneous coronary intervention. Seventeen had a scar area >75% in at least one antero- or inferoseptal segment (scar) and 13 had scar <1% (non-scar). The phase delays of velocity, displacement and strain were measured in the longitudinal direction, tangential to the endocardial outline, and in the radial direction, perpendicular to the tangent. Results. The standard deviation of phase in radial measurements differentiated scar patients from those without scar (p<0.01), while longitudinal measurements did so only for longitudinal strain. Likewise, the standard deviation for radial measurements of time to peak for segmental velocity, displacement and strain performed better than longitudinal measurements and equal to the results of phase. Conclusion. Phase dispersion in deformation imaging may be used for detecting heterogeneous left ventricular contraction.

Place, publisher, year, edition, pages
Informa Healthcare, 2015
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-115752 (URN)10.3109/14017431.2015.1023343 (DOI)000354402500007 ()25752486 (PubMedID)
Available from: 2015-03-18 Created: 2015-03-18 Last updated: 2017-12-04
Lagerqvist, B., Frobert, O., Olivecrona, G. K., Gudnason, T., Maeng, M., Alstrom, P., . . . James, S. K. (2014). Outcomes 1 Year after Thrombus Aspiration for Myocardial Infarction. New England Journal of Medicine, 371(12), 1111-1120
Open this publication in new window or tab >>Outcomes 1 Year after Thrombus Aspiration for Myocardial Infarction
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2014 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 371, no 12, p. 1111-1120Article in journal (Refereed) Published
Abstract [en]

BACKGROUND Routine intracoronary thrombus aspiration before primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) has not been proved to reduce short-term mortality. We evaluated clinical outcomes at 1 year after thrombus aspiration. METHODS We randomly assigned 7244 patients with STEMI to undergo manual thrombus aspiration followed by PCI or to undergo PCI alone, in a registry-based, randomized clinical trial. The primary end point of all-cause mortality at 30 days has been reported previously. Death from any cause at 1 year was a prespecified secondary end point of the trial. RESULTS No patients were lost to follow-up. Death from any cause occurred in 5.3% of the patients (191 of 3621 patients) in the thrombus-aspiration group, as compared with 5.6% (202 of 3623) in the PCI-only group (hazard ratio, 0.94; 95% confidence interval [CI], 0.78 to 1.15; P = 0.57). Rehospitalization for myocardial infarction at 1 year occurred in 2.7% and 2.7% of the patients, respectively (hazard ratio, 0.97; 95% CI, 0.73 to 1.28; P = 0.81), and stent thrombosis in 0.7% and 0.9%, respectively (hazard ratio, 0.84; 95% CI, 0.50 to 1.40; P = 0.51). The composite of death from any cause, rehospitalization for myocardial infarction, or stent thrombosis occurred in 8.0% and 8.5% of the patients, respectively (hazard ratio, 0.94; 95% CI, 0.80 to 1.11; P = 0.48). The results were consistent across all the major subgroups, including grade of thrombus burden and coronary flow before PCI. CONCLUSIONS Routine thrombus aspiration before PCI in patients with STEMI did not reduce the rate of death from any cause or the composite of death from any cause, rehospitalization for myocardial infarction, or stent thrombosis at 1 year.

Place, publisher, year, edition, pages
Massachusetts Medical Society, 2014
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-111257 (URN)10.1056/NEJMoa1405707 (DOI)000341687300006 ()25176395 (PubMedID)
Note

Funding Agencies|Swedish Research Council; Swedish Association of Local Authorities and Regions; Terumo Medical; Medtronic; Vascular Solutions; Swedish Heart-Lung Foundation [20100178, B0010401]; Landspitali University Hospital

Available from: 2014-10-15 Created: 2014-10-14 Last updated: 2017-12-05
Sarno, G., Lagerqvist, B., Nilsson, J., Frobert, O., Hambraeus, K., Varenhorst, C., . . . James, S. K. (2014). Stent Thrombosis in New-Generation Drug-Eluting Stents in Patients With STEMI Undergoing Primary PCI. Journal of the American College of Cardiology, 64(1), 16-24
Open this publication in new window or tab >>Stent Thrombosis in New-Generation Drug-Eluting Stents in Patients With STEMI Undergoing Primary PCI
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2014 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 64, no 1, p. 16-24Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Some concerns still have not been resolved about the long-term safety of drug-eluting stents (DES) in patients with acute STEMI.

OBJECTIVES:

The aim of this study was to evaluate the stent thrombosis (ST) rate up to 3 years in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (n-DES) compared with bare-metal stents (BMS) and old-generation drug-eluting stents (o-DES) enrolled in the SCAAR (Swedish Coronary Angiography and Angioplasty Registry).

METHODS:

From January 2007 to January 2013, 34,147 patients with STEMI were treated by PCI with n-DES (n = 4,811), o-DES (n = 4,271), or BMS (n = 25,065). The risks of early/late (up to 1 year) and very late definite ST (after 1 year) were estimated.

RESULTS:

Cox regression landmark analysis showed a significantly lower risk of early/late ST in patients treated with n-DES (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.43 to 0.99; p = 0.04) and o-DES (HR: 0.60; 95% CI: 0.41 to 0.89; p = 0.01) compared with the BMS group. The risk of very late ST was similar between the n-DES and BMS groups (HR: 1.52; 95% CI: 0.78 to 2.98; p = 0.21), whereas a higher risk of very late ST was observed with o-DES compared with BMS (HR: 2.88; 95% CI: 1.70 to 4.89; p < 0.01).

CONCLUSIONS:

Patients treated with n-DES have a lower risk of early/late ST than patients treated with BMS. The risk of very late ST is low and comparable between n-DES and BMS up to 3 years of follow-up, whereas o-DES treatment is associated with an increased risk of very late ST. The current STEMI guidelines might require an update in light of the results of this and other recent studies.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
drug-eluting stent(s); percutaneous coronary intervention; ST-segment elevation myocardial infarction
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-109377 (URN)10.1016/j.jacc.2014.04.022 (DOI)000339337700003 ()24998123 (PubMedID)
Available from: 2014-08-15 Created: 2014-08-15 Last updated: 2017-12-05Bibliographically approved
Tödt, T., Thylén, I., Alfredsson, J., Swahn, E. & Janzon, M. (2013). Strategies TO reduce time delays in patients with AcuTe coronary heart diasease treated with primary PCI - the STOP WATCH study: a multistage action research project. BMJ Open, 3(3493)
Open this publication in new window or tab >>Strategies TO reduce time delays in patients with AcuTe coronary heart diasease treated with primary PCI - the STOP WATCH study: a multistage action research project
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2013 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 3493Article in journal (Refereed) Published
Abstract [en]

Objective

To identify, evaluate and reduce system delay times in an ST-elevation myocardial infarction (STEMI) network by targeted reorganisation of logistics and personal feedback to staff on time delays.

Design

Multistage action research project. Three study phases were used (exploration, tailored intervention and evaluation).

Setting

Single centre study, Sweden.

Patients

Consecutive patients (N=156) with prehospital STEMI onset treated with primary percutaneous coronary intervention (PCI).

Interventions

Areas of delays were identified through participant observations and collaborative discussions. To increase the awareness of delay factors, continuous feedback on time delays was given. Elements of the logistics’ reorganisation were (1) prioritised ECG recording by emergency medical services personnel, (2) central evaluation of ECG in all patients and (3) start of PCI procedure when two of three PCI team members were on site. Multiple key time measurements were made before (N=67) and after (N=89) the intervention.

Main outcomes

Time difference (minutes) in system delay between the preintervention and postintervention phases.

Results

Time from first medical contact (FMC) to a patent artery and time from FMC-to-catheter laboratory (cath-lab) arrival decreased by 6 and 12 min, respectively (ns). Time from FMC-to-ECG recording remained unchanged after the intervention. Time from ECG to decision for primary PCI was reduced by 6 min, p=0.004 and time from ECG-to-cath-lab arrival by 11 min, p=0.02. Total time from diagnosis to a patent artery decreased by 11 min (ns).

Conclusions

Identification of time delays in an STEMI network with awareness of delay factors, reorganisation of logistics and continuous feedback can reduce system delay times significantly.

Place, publisher, year, edition, pages
BMJ Publishing Group, 2013
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-99863 (URN)10.1136/bmjopen-2013-003493 (DOI)000330541900066 ()
Available from: 2013-10-22 Created: 2013-10-22 Last updated: 2017-12-06Bibliographically approved
Tödt, T., Thylén, I., Alfredsson, J., Swahn, E. & Janzon, M. (2013). Strategies to reduce time delays in patients with acute coronary heart disease treated with primary PCI.. In: : . Paper presented at ESC Congress 2013. Amsterda, Netherlands
Open this publication in new window or tab >>Strategies to reduce time delays in patients with acute coronary heart disease treated with primary PCI.
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2013 (English)Conference paper, Published paper (Refereed)
Place, publisher, year, edition, pages
Amsterda, Netherlands: , 2013
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-103483 (URN)
Conference
ESC Congress 2013
Available from: 2014-01-20 Created: 2014-01-20 Last updated: 2014-01-20
Tödt, T., Maret, E., Alfredsson, J., Janzon, M., Engvall, J. & Swahn, E. (2012). Relationship between the duration of ischemia and final infarct size in STEMI patients treated with abciximab and primary PCI.. In: : . Paper presented at Journal of Cardiovascular Magnetic Resonance. SMCR, Orlando, Florida (pp. P21-P21). SMCR, Orlando, Florida
Open this publication in new window or tab >>Relationship between the duration of ischemia and final infarct size in STEMI patients treated with abciximab and primary PCI.
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2012 (English)Conference paper, Published paper (Refereed)
Place, publisher, year, edition, pages
SMCR, Orlando, Florida: , 2012
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-103420 (URN)
Conference
Journal of Cardiovascular Magnetic Resonance. SMCR, Orlando, Florida
Available from: 2014-01-20 Created: 2014-01-20 Last updated: 2014-01-20
Tödt, T., Maret, E., Alfredsson, J., Janzon, M., Engvall, J. & Swahn, E. (2012). Relationship between treatment delay and final infarct size in STEMI patients treated with abciximab and primary PCI. BMC Cardiovascular Disorders, 12(9), 1-9
Open this publication in new window or tab >>Relationship between treatment delay and final infarct size in STEMI patients treated with abciximab and primary PCI
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2012 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 12, no 9, p. 1-9Article in journal (Refereed) Published
Abstract [en]

Background

Studies on the impact of time to treatment on myocardial infarct size have yielded   conflicting results. In this study of ST-Elevation Myocardial Infarction (STEMI) treated   with primary percutaneous coronary intervention (PCI), we set out to investigate the   relationship between the time from First Medical Contact (FMC) to the demonstration   of an open infarct related artery (IRA) and final scar size.

Between February 2006 and September 2007, 89 STEMI patients treated with primary PCI   were studied with contrast enhanced magnetic resonance imaging (ceMRI) 4 to 8 weeks   after the infarction. Spearman correlation was computed for health care delay time   (defined as time from FMC to PCI) and myocardial injury. Multiple linear regression   was used to determine covariates independently associated with infarct size.

Results

An occluded artery (Thrombolysis In Myocardial Infarction, TIMI flow 0-1 at initial   angiogram) was seen in 56 patients (63%). The median FMC-to-patent artery was 89 minutes.   There was a weak correlation between time from FMC-to-patent IRA and infarct size,   r = 0.27, p = 0.01. In multiple regression analyses, LAD as the IRA, smoking and an occluded vessel   at the first angiogram, but not delay time, correlated with infarct size.

Conclusions

In patients with STEMI treated with primary PCI we found a weak correlation between   health care delay time and infarct size. Other factors like anterior infarction, a   patent artery pre-PCI and effects of reperfusion injury may have had greater influence   on infarct size than time-to-treatment per se.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-80591 (URN)10.1186/1471-2261-12-9 (DOI)000304351000001 ()
Available from: 2012-08-27 Created: 2012-08-27 Last updated: 2017-12-07
Tödt, T. (2012). Strategies to improve outcome in patients with ST elevation myocardial infarction treated with primary PCI. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Strategies to improve outcome in patients with ST elevation myocardial infarction treated with primary PCI
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: ST elevation myocardial infarction (STEMI) caused by a ruptured atherosclerotic plaque with overlying thrombosis leads to ischemia and progressively to the death of the myocardial cells supplied by the affected coronary artery. Rapid reperfusion with primary Percutaneous Coronary Intervention (PCI) in an experienced centre is the preferred therapy for these patients. The aim of the research program on which this thesis is based was to study the effect of antiplatelet therapy with abciximab on coronary patency  when administered early to an unselected cohort of patients with STEMI intended for primary PCI, to study the impact of health care delay time on infarct size measured with contrast enhanced Magnetic Resonance Imaging (ceMRI), and to evaluate if time delays could be reduced through reorganisation of logistics and personal feedback to staff involved in the care of STEMI patients. Finally measures of wall motion on cine MRI were evaluated to elucidate if functional measurements of the left ventricular wall could detect scar tissue visualised on ceMRI in a post-acute phase of primary PCI.

Material and results: In paper I we report on a study of all consecutive patients who sustained a STEMI in 2005 in the county of Östergötland and who were to be treated with primary PCI. Abciximab given as pretreatment before (n=133) or at the cath-lab after a diagnostic angiography (n=109) was associated with a patent Infarct Related Artery (IRA), i.e. Thrombolysis in Myocardial Infarction (TIMI) flow 2-3, in 45.9% of patients in the early group versus 20.2% in the cath-lab group, p=0.0001. There were no statistically significant differences in bleeding or mortality rate during the initial hospital stay, nor were there any significant differences between the groups during one-year follow up regarding a Major Adverse Cardiac Event (MACE).

Paper II is based on an examination of 30 patients in a stable clinical condition with ceMRI 4-8 weeks after they had been treated with primary PCI because of STEMI. Patients were selected on the presence of extensive myocardial scar in the anteroseptal segments (n=17) or no scar visible at all in this area or in any other part of the myocardium (n=13). The purpose of the study was to evaluate the ability of a new feature tracking software to measure functional parameters of the heart. The left ventricular wall was divided into 18 segments and myocardial contraction was measured with velocity, displacement and strain in the longitudinal and radial direction. The software calculated a mean value for the 18 segments for each parameter. Receiver-operatorcharacteristics curves (ROC) were constructed. The best area-under-curve (AUC) was for radial strain where a cut-off value of 38.8% had 80% sensitivity and 86% specificity to detect segments with scar>50%.

The impact of health care delay was examined in paper III based on a study in which 89 STEMI patients treated with primary PCI had their infarct size measured with ceMRI in the post-acute phase. Time from First Medical Contact (FMC) to a patent artery correlated weakly with infarct size, r=0.27, p=0.01. However, multivariable analysis showed the LAD as the Infarct Related Artery (IRA), active smoking and occlusion of the IRA at the time of the diagnostic angiogram were correlated with infarct size and that time from FMC to patent artery was not so correlated.

Finally, in the study leading to paper IV, extensive measurements on time delays were performed on 67 consecutive patients with STEMI treated with primary PCI. Through collaboration with different stakeholders in the treatment of STEMI in the catchment area the following types of targeted refining of logistics were done; 1. Ambulance staff prioritise ECG recording, 2. Central evaluation of ECG in all patients with suspected STEMI, and 3. PCI team is ready to accept the patient when two out of three members are on site. Moreover, personal feedback on time delays for each STEMI patient was given to all staff involved in the treatment of the patient. Thereafter, all the time delays for a similar group of consecutive STEMI patients (n=89) were analysed and compared with the delays for the former group. Improvements seen in the post-intervention group were a reduction in time from ECG to cath-lab arrival by 11 minutes, p=0.02 and a non-significant decrease of FMC to a patent artery by six minutes. The main part of this improvement could probably be ascribed to the decision to see to it that an attending cardiologist was present 24/7 and to central evaluation of ECG.

Conclusion: Abciximab given as pre-treatment to patients with STEMI intended for primary PCI was associated with a patent artery in 46% of patients. Moreover, we demonstrated a relationship between health care delay time and infarct size. This delay time could be reduced by a reorganisation of logistics and personal feedback on time delays. Finally, feature tracking analysis of cine MR images could detect segments with extensive myocardial scar in anterior infarction with 80% sensitivity and 86% specificity.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. p. 78
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1327
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-85808 (URN)978-91-7519-798-2 (ISBN)
Public defence
2012-12-14, Berzeliussalen, Universitetssjukhuset, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2012-11-28 Created: 2012-11-28 Last updated: 2014-03-07Bibliographically approved
Lawesson, S., Tödt, T., Alfredsson, J., Janzon, M., Stenestrand, U. & Swahn, E. (2011). Gender difference in prevalence and prognostic impact of renal insufficiency in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Heart, 97(4), 308-314
Open this publication in new window or tab >>Gender difference in prevalence and prognostic impact of renal insufficiency in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention
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2011 (English)In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 97, no 4, p. 308-314Article in journal (Refereed) Published
Abstract [en]

Objective To evaluate if female gender is associated with renal insufficiency in patients with ST-elevation myocardial infarction (STEMI) and if there is a gender difference in the prognostic importance of renal insufficiency in STEMI. Design Single-centre observational study. Setting One tertiary cardiac centre. Patients All consecutive patients with STEMI planned for primary percutaneous coronary intervention in one Swedish county in 2005 (98 women and 176 men). Main outcome measures Logistic regression analyses were conducted to evaluate the predictors of renal insufficiency, associations between estimated glomerular filtration rate (eGFR) and outcome in each gender and a possible interaction between gender and eGFR regarding outcome. Results Renal insufficiency was defined as eGFR less than 60 ml/min per 1.73 m(2). 67% of women had renal insufficiency compared with 26% of men, OR 5.06 (95% CI 2.66 to 9.59) after multivariable adjustment. In women each 10 ml/min per 1.73 m 2 increment of eGFR was associated with a 63% risk reduction for 1-year mortality, OR 0.37 (95% CI 0.15 to 0.89). No such association was found in men, OR 1.05 (95% CI 0.63 to 1.76). A trend towards a significant interaction between gender and eGFR regarding 1-year mortality was found, OR 2.05 (95% CI 0.93 to 4.50). Conclusions A considerable gender difference in the prevalence of renal insufficiency in STEMI was found and renal insufficiency seemed to be a more important prognostic marker in women. These results are important as previous STEMI studies have shown higher multivariable adjusted mortality in women than in men but renal function has seldom been taken into consideration.

Place, publisher, year, edition, pages
BMJ Publishing Group; 1999, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-65947 (URN)10.1136/hrt.2010.194282 (DOI)000286459400008 ()
Note
Original Publication: Sofia Lawesson, Tim Tödt, Joakim Alfredsson, Magnus Janzon, Ulf Stenestrand and Eva Swahn, Gender difference in prevalence and prognostic impact of renal insufficiency in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention, 2011, HEART, (97), 4, 308-314. http://dx.doi.org/10.1136/hrt.2010.194282 Copyright: BMJ Publishing Group; 1999 http://group.bmj.com/ Available from: 2011-02-28 Created: 2011-02-28 Last updated: 2017-12-11Bibliographically approved
Tödt, T., Maret, E., Alfredsson, J., Janzon, M., Engvall, J. & Swahn, E. (2011). Relationship between ischemia duration and final infarct size in STEMI patients treated with prehospital abciximab and primary PCI.. In: : . Paper presented at XIII Svenska Kardiovaskulära Vårmötet i Örebro. Örebro
Open this publication in new window or tab >>Relationship between ischemia duration and final infarct size in STEMI patients treated with prehospital abciximab and primary PCI.
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2011 (English)Conference paper, Published paper (Refereed)
Place, publisher, year, edition, pages
Örebro: , 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-103416 (URN)
Conference
XIII Svenska Kardiovaskulära Vårmötet i Örebro
Available from: 2014-01-20 Created: 2014-01-20 Last updated: 2014-01-20
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